Agenda item

To consider the report of the Director of Transformation and Governance on proposals from the NHS or providers of health services to vary or develop health services in the area of the Committee.

Items for Monitoring

·      North Hampshire CCG and West Hampshire CCG: Transforming Care Services in North and Mid Hampshire - proposals

NHS NORTH HAMPSHIRE CLINICAL COMMISSIONING GROUP AND NHS WEST HAMPSHIRE CLINICAL COMMISSIONING GROUP: TRANSFORMING CARE SERVICES IN NORTH AND MID HAMPSHIRE

The Chief Executive Officers from Hampshire CCG Partnership (representing North Hampshire CCG) and West Hampshire CCG presented a report on Transforming Care in North and Mid Hampshire (see report, Item 6 in the Minute Book).  Also in attendance was the Chief Executive of Hampshire Hospitals NHS Foundation Trust, the Programme Director for Transforming Care Services, and the Clinical Chair of North Hampshire CCG, in order to answer questions from the Committee.

Members heard that the CCGs and Trust had been working closely together, as well as with other acute hospital trusts and social care, in order to arrive at the proposals considered on 30 November.  The papers considered at the joint meeting in public of the two CCGs highlighted the significant work that had been ongoing, including progress made by the clinical reference groups and stakeholder groups.  The proposals had benefited from input from both University Hospital Southampton NHS Foundation Trust and Frimley Health NHS Foundation Trust as the two acute services potentially impacted by any change to how Hampshire Hospitals are organised, as well as that from clinicians and GPs, and representatives from both Winchester and Basingstoke Councils.

Through joint working, a shared vision for health and social care had been developed, which focused on both in and out of hospital care.  This vision would meet best practice and enable access to specialist care for the sickest and most dependent patients.  It also aimed to tackle the challenge of a changing population demographic in Hampshire, with data showing that there was an increase of people in Hampshire who are ageing and suffering from long-term chronic conditions.

The CCGs and their partners recognised that there had been a lot of changes since 2012, not least the current financial situation which was much more challenging for the NHS.  Since this time, there had also been the publication of the national NHS strategies on the ‘Five Year Forward View’ and ‘General Practice Forward View’, which had impacted significantly on how service changes are delivered.  These developments in NHS policy had also introduced the need for hospitals to provide specialist care 24 hours a day, seven days a week.  Greater working between the NHS and social care through the Better Care Fund was also an important development, with much more impetus on working in partnership to provide joined up care. 

For the reasons above, the CCGs had felt it appropriate to revisit the approach taken to reviewing services in North and Mid Hampshire, although it was appreciated that it had been a long journey to reach this point.  In reaching the most recent set of proposals, the CCGs had felt it important to engage with external partners to develop what the future of all services, including primary care and community services might look like, rather than a sole focus on acute services, and through this, a new hospital building.  A piece of public engagement work had been undertaken, asking the local population whether they understood centralisation and the impact this had on access to services.  The outcomes had been that generally the public do understand and support centralisation, as long as services remain accessible, accepting that this approach provides safer care in the long term.  The only caveat to this finding was for maternity services, where the public were more hesitant about supporting centralisation.

At a meeting held in public on 30 November the two CCG Boards had concluded that building a new Critical Treatment Hospital was not the preferred option for the future of services in North and Mid Hampshire, with the approach agreed to instead centralise services within the three Hampshire Hospitals sites already in existence.  To this end, the CCGs would continue working in partnership with the Trust to bring this model to fruition, which was felt by all parties (should the model be the right one) to meet the needs of the changing Hampshire population.

Since the decision was taken to concentrate on the centralisation model, the CCGs and Trust had been undertaking work with partners to assess the current estate.  There had also been a stocktake of community services to understand what is working and what isn’t, keeping a core focus on out-of-hospital services that reduce pressure on the Trust.  Once this work had been completed, partners would be determining which services could most appropriately be moved.  It was expected that any new model would need the support of Capital Programme funding, in order to improve the estate and make it fit for purpose, and there was expected to be a bidding process to apply for any such monies.  A further report was due to be heard by the CCGs in March 2018, which would detail the progress made against these elements of the programme.

An overview was provided by the Clinical Chair of North Hampshire CCG of the model envisaged for North and Mid Hampshire, helping to keep people well for as long as possible, to provide joined-up care that individuals feel in charge of, to be responsive, and to have access to the right people at the right time.  It was hoped that the outcomes of the ‘transforming care services’ work would be a more holistic model of health and social care for the population, based around multi-disciplinary teams in the community, with individuals only accessing hospital care when it was appropriate and unavoidable.

In response to questions, Members heard:

·         That an assessment of the current Hampshire Hospitals estate needed to be undertaken before further decisions could be taken on centralisation, as partners needed to understand the state of the building stock and footprint for potential expansion. 

·         Once a decision had been taken by the CCGs, the Chief Executive of the Trust had discussed the proposals with her senior clinical leaders, in order to understand any concerns around sustainability or the safety of services.  In the short-term, there were not concerns about services continuing.  For those services that would have been centralised in the Critical Treatment Hospital, the Trust were reviewing with its external partner the benefits and consequences of centralising these, and this work was still ongoing.  It was hoped that this work would report in March.

·         That the Trust’s key concerns at this time were finance and workforce, which were both under pressure.  The message received from clinicians, which had been validated by data, was to question the affordability of providing the services that are duplicated across the hospital sites.  This was complicated by centralisation not always resulting in savings, as patient activity might remain the same.

·         All the partners were signed up to the model described, as hospitals needed to see a decrease in activity and a shift towards out-of-hospital care as the norm.  The Trust would be involved in providing services that assisted individuals to stay well outside of hospital. 

·         Once the model was implemented, work would need to take place to engage the public that hospital isn’t always the best place to be.  The NHS needed to break away from the reliance on the hospital as the centre of care, and instead build investment into community services.  The CCGs and Trust believed that if the model of primary and community care envisaged could be achieved, then bed numbers in the Trust could potentially decrease, rather than increase.

·         That a senior stakeholder group had contributed throughout the programme, which included membership from the ambulance service and other acute trusts with an interest in what the final model would look like.  The Trust worked closely with other hospital trusts in Hampshire and held regular conversations with University Hospitals Southampton NHS Foundation Trust and Frimley Health NHS Foundation Trust.

·         The questions posed in the engagement exercise referred to in the report were determined with assistance from a public and patient engagement group, with these focused on general thoughts around centralisation, rather than specifics.  The CCGs and Trust had undertaken extensive engagement over the previous six years and have found this helpful for informing proposals.  The CCGs were content to share the findings from the most recent engagement exercise with Members, and would provide details of that undertaken in East Hampshire with the relevant member.

·         The way primary care services, particularly the general practice model, operate was changing and  the partnership model was under threat as a result of a retiring workforce, but with new GPs coming into the system, it was an opportunity to work in a new model.  What was emerging were new contracting opportunities and a multi-disciplinary team model, which was exciting.  The CCGs were aware that new GPs want the flexibility to work in a portfolio way, rather than the traditional tie-in partnership contracts.

·         Some areas of Hampshire already have GPs working for community providers or hospitals, whereas in others the partnership model continued to thrive.  The future model of primary care was one that would be discussed at the next health member briefing session on 7 February.

RESOLVED

That Members:

1.  Note the proposals on ‘transforming care services in North and Mid Hampshire‘.

2. Invite partners involved in the programme to return to the May 2018 meeting of the Committee, in order that further progress can be reported, specifically on the centralisation and out-of-hospital care models.